When cold temperatures arrive and winter precipitation increases EMS must remind our communities to be vigilant about the dangers of carbon monoxide.
Every winter people fire up old heaters that have not been used or maintained in many months. The indoor use of outdoor heat sources, such as gas grills or generators, and other inappropriate or illegal devices is a recipe for disaster.
For us responders, it’s time to remind ourselves about scene management issues as related to carbon monoxide:
1. Identify potential for an MCI
Recently, four FDNY EMS providers and 7 residents were sickened by a CO leak at Bronx apartment building. Unfortunately there will probably be more than a few stories being reported this winter about first responders becoming ill while treating patients within the toxic environment. Stay alert! The vast majority of the time the patient with a headache, nausea, vomiting and fatigue is in fact someone with flu or severe cold symptoms; try to consciously ask whether a heater is in use, and if so, where. Having more than one victim on the scene with similar signs is a red flag.
2. Evacuate!
If the potential for carbon monoxide exists, evacuate immediately. Prevent curious bystanders and other rescuers from entering the home. Make the scene safer for yourself, other responders, and the patients by evacuating.
3. Call for additional resources
If you can leave with the patients safely, then do so, but your safety is the primary concern. If you are trained to use SCBA, retreat and don the necessary equipment to regain access safely. If not, call for additional resources and prepare to receive the patients out in the cold zone.
4. Understand the pathophysiology of CO
Carbon monoxide kills by robbing hemoglobin of their ability to hold oxygen. This causes the patient to effectively suffocate. High concentrations of oxygen can begin the process of bumping carbon monoxide molecules off the hemoglobin cells. Assess that the patient is ventilating effectively – look for adequate rate and depth of breathing. Don’t trust your pulse oximeter, as it will show abnormally high readings. A carbon monoxide monitor can provide key information and alert you to dangerous levels of CO.
5. Follow local protocols for transport to a hyperbaric chamber
In more severe cases of CO poisoning, a facility that has access to a hyperbaric chamber may be needed. Oxygen under increased atmospheric pressure will help drive more CO off the hemoglobin. Review your destination policies and procedures to make sure you are transporting to the appropriate facility.
This article, originally published on Nov. 30, 2010, has been updated.
